This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Tuesday, 10 February 2009

Why do Nurses always look like hell?

It's true. We look like slobs.

First problem is the uniforms. Right now I have only one that fits. I am not allowed to have anymore from the trust due to financial cutbacks. I am not allowed to buy my own uniforms outside of the trust. I sometimes leave work at 10PM at night and have to be back at 7AM the next day. I am a clean freak so that means that everytime I come home from work I wash the uniform and put it in the drier before I go to bed. I do this even if I left at 10PM and have to be back at 7AM the next day.

I get up at 5AM to get ready for my early shift and take the uniform out of the drier and iron it. Then it goes in a carrier bag and sits by the door while I get dressed. The uniform has been worn and washed so many times it looks like hell no matter what I do. If you get caught traveling to and from work in your uniform you are instantly dismissed. They have already made a few examples.

We are told that we need to change at work or else but there are no changing facilities. I think the other section of the hospital has them but we were not allowed to use them. There are portacabins outside (a 20 minute walk away)full of mice and we were told to use those but no one has given us a code to get into them.

Staff on my ward have to change in the domestics cupboard just outside the doors to the ward. It is very small and usually there are 2 of us in there getting changed. When someone else comes in and opens the door....anyone in the foyer can see us. This especially sucks during the 1PM start when countless visitors are standing around in that foyer.

Some of us started sneaking to the toilets to change but they were caught and told that this is unacceptable and to use the supply cupboard or the mice-a-cabin as I call it. The trust will NOT launder or store our uniforms, or give out new ones at this point. Other trusts do it, and they provide decent facilities for their staff as well.

So my worn out uniform has been carried to work in a sainsbury's bag and I have changed into while trying not to fall into an old cleaning bucket. My normal clothes get stored in the sainsbury's bag on the floor of the cleaning cupboard. There are 5 tiny lockers for everyone.

I am still meticulous about my appearance otherwise. I plait my long hair and wind it up in a coil for work. I pin every stray piece in place. I always shower before and after every shift. My nails are short and they get scrubbed and clipped again before work. I wear minimal natural make up so I don't scare the patients. I wear expensive shoes to work. They are very smart and comfortable. I'm a vain little shit.

10 hours into my shift without any sort of break the other day I caught a glimpse of myself in a mirror and nearly choked. Strands of hair all over the place, dry chapped peeling lips, bags under my eyes, stains on my face from crying after a death and a uniform that looks like it has seen heavy duty daily use since 1950.

This is actually very demoralizing because I am usually a snob about appearance and like to look good. I stay healthy and fit and take care of myself. I like expensive make up and beauty products and never wear the same outfit twice. I always take loads of time before work to try and look reasonable even if it means getting up at 5AM.

But that brief glimpse in the mirror showed me that during a long shift I look like the slovenly pig nurse that the public always complaints about.

If I could get a break during a shift I would redo my hair, apply some powder and lipgloss and clean my self up. Care assistants, secretaries, domestics and everyone else get time during the day to do this. I cannot even go pee without getting behind and making my patients angrier. Those of you who can take time during the work day for a makeup and hair check make me sick.

When I worked overseas the nurses bought their own uniforms from nursing stores. I never wore the same outfit to work twice. Like I said I am vain and can spend some serious money on clothes. I looked so much better. The uniforms I chose for myself were nicer with good labels and they were better quality and more professional than the shit the NHS gives us. I even bought uniforms made from bacterial resistant fabrics.

Older nurses that haven't worked in awhile may find this shocking as they were always supplied with fresh smart and clean uniforms every shift. They are also the ones who bitch the most about the appearance of todays nurses.

21 comments:

Thankfully my trust supply changing areas and launder uniforms, but what are your infection control team doing? Do they think that hygiene is saying hello to your aunt? I wont ask about unions as they are a waste of space at the moment.

Our infection control team is threatening us if they catch us coming to and from work wearing uniforms. They don't give a damn about the fact that my uniform is old, tatty and getting carried around in a supermarket bag. They don't care that we are getting changed in a tight, dirty supply cupboard or that the nurse patient ratio issue is the biggest threat to infection control.

Remember, its all about giving the public what they want to see, not about actually dealing with any issues. Joe Public thinks that the infection control problems are down to the nurses driving home in the uniforms. They don't understand that all the other stuff is a bigger infection problem.

I don't even know where to start. I guess quiting and working somewhere else isn't much of an option. Perhaps a group of you need to get together and file a class action law suit against your employer. Granted I work in an ER in the US and not in the UK but there must be some course of action you can take.

If you have the means come over here to the US. We have many openings for good nurses, and you get to speak your mind now and then telling MDs off when they get out of line.

Perhaps the grass isn't greener over here but I have never heard of what you are speaking of take place in the US - despite how screwed up it is at times.

I do hold a current US nursing license Mike. Like an idiot I came home to the UK after qualifying. Family commitments are keeping me here now but I will always maintain my US license. I won't say which state.

Many things about nursing in 1971, which is when I started training, were seriously bad: non-existent infection control policies, sloppy infection control techniques, inadequate supplies of disposable gloves (coupled with non-existent supplies of incontinence wipes and I'm sure I don't have to spell out what this meant in practice).

Strangely enough though, every hospital I worked in had male and female changing rooms and we were always supplied with at least 6 sets of uniform which were duly washed, starched, pressed and returned to us, usually on a weekly turnaround. Each uniform also had one's name embroidered on it. How on earth has NHS management been allowed to get away with making uniform supply so much worse than it was nearly 40 years ago?

Trusts that are trying to cut back financially are cutting costs everywhere. You get 3 uniforms when you start. If they become tatty or start falling apart or your weight changes you need to beg for more.

Some of the sisters found round about ways of getting their nurses more uniforms. They got busted.

One of my HCA's was down to one pair of trousers with a big gaping whole down both thighs. Took her months to get another pair. She was so uncomfortable.

Most of us are buying our own trousers. If we get caught they'll really come down on us.

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.